Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation
Authors: Derek S. Chew, Jonathan P. Piccini
Journal: Annals of Internal Medicine (2023)

LettersMarch 2023Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial FibrillationDerek S. Chew, MD, MSc, Jonathan P. Piccini, MD, MHSDerek S. Chew, MD, MScLibin Cardiovascular Institute and O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this author, Jonathan P. Piccini, MD, MHSDuke Clinical Research Institute, Duke University, and Division of Cardiology, Duke University Medical Center, Durham, North CarolinaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L22-0517 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We appreciate the concerns expressed by Dr. Anderson and colleagues. As they point out, there is no randomized evidence showing superiority of percutaneous LAAO in patients who either can or cannot tolerate OACs. However, as cited in our decision analyses, meta-analyses of randomized trials in those who can tolerate OACs show lower risks for cardiovascular mortality and cerebral hemorrhage in those treated with LAAO versus OACs (1).Consistent with guidance from the Centers for Medicare & Medicaid Services, we typically pursue LAAO after shared decision making in persons who are at risk for stroke but are not good ...References1. Sahay S, Nombela-Franco L, Rodes-Cabau J, et al. Efficacy and safety of left atrial appendage closure versus medical treatment in atrial fibrillation: a network meta-analysis from randomised trials. Heart. 2017;103:139-47. [PMID: 27587437] doi:10.1136/heartjnl-2016-309782 CrossrefMedlineGoogle Scholar2. Wazni OM, Boersma L, Healey JS, et al. Comparison of anticoagulation with left atrial appendage closure after atrial fibrillation ablation: rationale and design of the OPTION randomized trial. Am Heart J. 2022;251:35-42. [PMID: 35526570] doi:10.1016/j.ahj.2022.05.003 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Derek S. Chew, MD, MSc; Jonathan P. Piccini, MD, MHSAffiliations: Libin Cardiovascular Institute and O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, CanadaDuke Clinical Research Institute, Duke University, and Division of Cardiology, Duke University Medical Center, Durham, North CarolinaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4653. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLeft Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation Derek S. Chew , Ke Zhou , Sean D. Pokorney , David B. Matchar , Sreekanth Vemulapalli , Larry A. Allen , Kevin P. Jackson , Zainab Samad , Manesh R. Patel , James V. Freeman , and Jonathan P. Piccini Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation Christian E. Anderson , Randy A. Lieberman , Brian Olshansky Metrics March 2023Volume 176, Issue 3KeywordsAnticoagulantsAtrial fibrillationHemorrhageHemorrhagic strokeIschemic strokeQuality of lifeStroke ePublished: 21 March 2023 Issue Published: March 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...